Framework for Safe Nurse Staffing and Skill Mix: Phase 3

Phase 3 of the Framework is focused on safe nurse staffing and skill mix in general non-acute care settings. Phase 3 will include 3 different stages. Phase 3(i) applies to long-term residential care settings (LTRCs) for older persons. Phase 3(ii) applies to general community care settings and Phase 3(iii) applies to step down and rehabilitation care settings.

Phase 3(i) of the Framework for the LTRC settings is currently under development and is based on recommendation 5.4 of the COVID-19 Nursing Homes Expert Panel Report (“Framework for Safe Staffing and Skill mix should be prioritised and urgently developed to apply in nursing homes – public and private, nationally”). This is a unique stage of the framework development as it is the first time it will include public, private, and voluntary care settings.

A core component of the Safe Staffing Framework development is testing the evidence-based model, as selected by the Taskforce, in nine pilot sites capturing a representative sample of Ireland's long-term residential care facilities. The aim is to use the identified model to determine safe staffing levels and skill mix for the facility, based on an assessment of the residents' care need. This pilot testing will be underpinned by a programme of research that will measure resident, staff and organisational outcomes associated with staffing in LTRC settings for Older Persons.

The research team have undertaken an extensive review of the international literature and evidence around safe staffing in the LTRC settings for Older Persons and have provided a report to the Taskforce. The Taskforce have agreed to test the Nursing Hours per Resident Day (NHpRD) model in conjunction with the Resource Utilisation Group IV (RUG IV) instrument in nine Pilot sites around Ireland.

The Research team have educated and supported staff in all nine Pilot sites in the use of the RUG IV instrument and have obtained baseline data from the Pilot sites. This data will continue to be collected over several months, allowing for several data points to be collated. In addition to this, cross sectional data focusing on staff outcomes relating to the nursing work environment, job satisfaction, intention to leave, missed care and burnout has been collected from the pilot sites.

Work is currently underway to begin developing Phase 3(ii) of the Framework for Safe Nurse Staffing and Skill Mix in general community care settings.